Medical Mystery

[unkownill]

Male of 25 yrs, hetrosexual, unprotected/protected sex with numerous partners over past 3 years.  About 2 years ago after unprotected sex experienced severe body chills, fatigue, numbness in extremities, cold sores on lips.  Thought normal, no doctor visit.  Every three months, reocurring severe cold sores on lips and facial area, numbness hands/feet. Thought normal, no doctor visit.  9 months ago had unprotected sex with 2 different partners. 1 partner had severe yeast/itchy vaginal infection during sex.  3 weeks after sexual encounters I developed an urgent/frequent need to urinate, abdominal pain, feeling of not relieving myself after urinating, severe hemmroids, bloody stool, nocturia, straining to urinate, dribbling, sensitivity to lower abdominal area, trouble sleeping, fatigue.  Seen doctor, prescribed doxycycline(10 days) w/ no results, symptoms worsen. Seen (First) urologist, DRE negative, urinalysis negative, prostatic massage no infection, no prescription, symptoms worsened over one month period, developed itchy urethra.  Seen (Second) doctor for itchy urethra, prescribed meds for possible trichinotis (14 days) w/no results. Seen (Second) urologist, DRE tender prostate, BPH, urinalysis negative, kidney catscan negative, bladder ultrasound normal, prescribed flomax (10 days), ciprofloxacin (45 days), diagnosed Accute Prostatitis.  1 month later, symptoms worsen, severe itchy feeling in urethra, severe nocturia, severe tenderness in lower abdominal area.  Seen (Third) urologist, cystoscopy "ratty urethra/inflamed"/prostate normal, diagnosed urethritis/acute prostititis, prescribed 30 days cipro, no results, symptoms stayed the same.  3 months after 3rd urologist (after having symptoms for 6 months), seen (Third) doctor.  Diagnosed severe chronic non bactprostitis, prescribed 60 days ciprofloxacin and 4 weeks (4 pills) of diflucan.  Developed sever itchiness of urethra, large volume of clear discharge from urethra after each bowel movement, symptoms of nocturia.  Seen (Fourth) urologist 1 month ago,urinalysis normal, biopsy of clear discharge normal, cystoscopy normal, bladder ultrasound normal, DRE normal/no BPH/no tender, rectal ultrasound normal size prostate/no abcess (abscess), told illness unknown.  Seen (above Third) doctor.  Told prostate inflamed, prescribed cortizone steroid (16 days), zinc, non steroid anti inflammatory (30 days).  Today it has been exactly 8 months since symptoms started.  As of date symptoms include itchy urethra, clear discharge after bm, nocturia, feeling of bladder fullness, fatigue, feeling of constant hunger (even after meals), burning in urethra, sensitive abdominal area when pressed.  Cold sores have reoccured at times.  Tested for diabetes, HIV, chlamydia, gonnorhea, all w/ negative results.  PSA normal.  Doc, what could this be??? It has been a long past 8 months, starting to affect my livelihood.  Is it non bactprostatitis or could it be a severe Candida Albicans Infection? Worried, Please help.

[Kevin Pho, MD]

You have clearly had a comprehensive evaluation, with multiple physician examinations, tests and studies.  

Prostatitis can be difficult to treat and may require an extended course of antibiotics.  I would assume that basic tests like urine cultures and as well as culture of the discharge have already been done.  

At this time, I would consider a transrectal ultrasound of the prostate to evaluate for any prostatic abscesses.  If this is the case, it would need to be drained - antibiotics would not be effective.  

If the itchy urethra continues, a referral to a dermatologist can be considered.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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